2019 Medicare Part D Plan Formulary Information |
Community Care's Partnership Program Disabled (HMO SNP) (H2034-002-0)
Benefit Details
|
The Community Care's Partnership Program Disabled (HMO SNP) (H2034-002-0) Formulary Drugs Starting with the Letter M in Ozaukee County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $40.80 Deductible: $415 |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAGNESIUM SULFATE 50% VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAGNESIUM SULFATE INJECTION 5 GM/10ML |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAPROTILINE 25MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAPROTILINE 50MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAPROTILINE 75MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MARPLAN 10MG TABLET (100 CT) |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MATULANE 50 MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MAVYRET 100-40 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MECLIZINE 12.5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLIZINE 25 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEDROXYPROGESTERONE 10 MG TABLET [Provera] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEDROXYPROGESTERONE 150 MG/ML Syringe [Depo-Provera] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEDROXYPROGESTERONE 2.5 MG TABLET [Provera] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEDROXYPROGESTERONE 5 MG TABLET [Provera] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEFLOQUINE HCL 250 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEGESTROL 20 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEGESTROL 40 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEGESTROL ACET 40 MG/ML SUSP |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MEKINIST 0.5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEKINIST 2 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEKTOVI 15 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MELOXICAM 15 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MELOXICAM 7.5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEMANTINE 5-10 MG TITRATION PK [Namenda Titration] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEMANTINE HCL 10 MG TABLET [Namenda] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEMANTINE HCL 5 MG TABLET [Namenda] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MENEST 0.3MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MENEST 0.625MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MENEST 1.25MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MENVEO A-C-Y-W-135-DIP VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MERCAPTOPURINE 50 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEROPENEM 500MG/VIAL FOR INJECTION |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEROPENEM IV 1 GM VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESALAMINE 1,000 MG SUPP.RECT [Canasa] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESALAMINE 4 GM/60 ML ENEMA |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESALAMINE 800 MG DR TABLET DR [Asacol HD] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESALAMINE DR 1.2 GM TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MESNEX 400MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL 1,000 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METFORMIN HCL 500 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL 850 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL ER 1,000 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL ER 500 MG OSM-TB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL ER 500 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Metformin HCL ER tab 1000mg |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Metformin HCL ER tab 500mg |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHADONE 10 MG/5 ML SOLUTION |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHADONE 5 MG/5 ML SOLUTION |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHADONE HCL 10 MG TABLET [Methadose] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHADONE HCL 5 MG TABLET [Methadose] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Methazolamide 25 MG Oral Tablet |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHAZOLAMIDE 50 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Methenamine Hippurate 1g/1 |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHIMAZOLE 10 MG TABLET [Tapazole] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHIMAZOLE 5 MG TABLET [Tapazole] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHOCARBAMOL 500 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHOCARBAMOL 750 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHOTREXATE 2.5MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
METHOTREXATE 250 MG/10 ML VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
METHOTREXATE 50 MG/2 ML VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methoxsalen 10 mg Capsule [8-MOP] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLDOPA 250 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLDOPA 500 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 10 MG CHEW TABLET [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 10 MG TABLET [Ritalin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 10 MG/5 ML SOL Solution [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 2.5 MG CHEW TABLET [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 20 MG TABLET [Ritalin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 5 MG CHEW TABLET [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 5 MG TABLET [Ritalin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE 5 MG/5 ML SOLN Solution [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE CD 10 MG CAPSULE CPBP 30-70 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE CD 20 MG CAPSULE CPBP 30-70 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE CD 30 MG CAPSULE CPBP 30-70 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE CD 40 MG CAPSULE CPBP 30-70 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE CD 50 MG CAPSULE CPBP 30-70 [Metadate CD] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE CD 60 MG CAPSULE CPBP 30-70 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 10 MG TABLET [Methylin] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 18 MG TABLET ER 24 [Concerta] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 27 MG TABLET ER 24 [Concerta] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 36 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPHENIDATE ER 54 MG TABLET ER 24 [Concerta] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE ER 72 MG TABLET ER 24 [RELEXXII] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE LA 10 MG CAP CPBP 50-50 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE LA 20 MG CAPSULE CPBP 50-50 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE LA 30 MG CAP CPBP 50-50 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE LA 40 MG CAPSULE CPBP 50-50 [Ritalin LA] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPHENIDATE LA 60 MG CAPSULE CPBP 50-50 |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPREDNISOLONE 16MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPREDNISOLONE 32MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPREDNISOLONE 4 MG DOSEPK |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METHYLPREDNISOLONE 4 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPREDNISOLONE 8 MG ORAL TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOCLOPRAMIDE 5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOCLOPRAMIDE 5 MG/5 ML SOLN |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOLAZONE 10MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOLAZONE 2.5MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOLAZONE 5MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL SUCC ER 100 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL SUCC ER 200 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL SUCC ER 25 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL SUCC ER 50 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL TARTRATE 100 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL TARTRATE 25 MG TAB |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT) |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE 0.75% CREAM Cream (g) [Vitazol] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE 0.75% LOTION [MetroLotion] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE 250 MG TABLET [Flagyl] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE 375 MG CAPSULE [Flagyl] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE 500 MG TABLET [Flagyl] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE TOPICAL 1% GEL [MetroGel] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEXILETINE 150MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEXILETINE 200MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MEXILETINE 250MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MICONAZOLE 3 200MG SUPPOS. |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIDODRINE HCL 10 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIDODRINE HCL 2.5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIDODRINE HCL 5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIGLUSTAT 100 MG CAPSULE [Zavesca] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE 100 MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE 50 MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE 75 MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE HCL 100 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE HCL 75 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOCYCLINE HYDROCHLORIDE TABLETS 50MG |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOXIDIL 10MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MINOXIDIL 2.5MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIRTAZAPINE 15 MG ODT |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIRTAZAPINE 15 MG TABLET [Remeron] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIRTAZAPINE 30 MG ODT |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIRTAZAPINE 30 MG TABLET [Remeron] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Mirtazapine 45 mg odt |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIRTAZAPINE 45 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MIRTAZAPINE 7.5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
misoprostol 100 mcg tablet |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
misoprostol 200 mcg tablet |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MODAFINIL 100 MG TABLET [Provigil] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MODAFINIL 200 MG TABLET [Provigil] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOLINDONE HCL 10 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOLINDONE HCL 25 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOLINDONE HCL 5 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOMETASONE FUROATE 0.1% CREAM (g) [Elocon] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOMETASONE FUROATE 0.1% OINT |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOMETASONE FUROATE 0.1% SOLUTION |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MONTELUKAST SOD 10 MG TABLET [Singulair] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MONUROL 3 GM SACHET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE 2 MG/ML SYRINGE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE 4 MG/ML SYRINGE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE 5 MG/ML SYRINGE |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE 8 MG/ML SYRINGE [Duramorph] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF 10 MG/5 ML Solution [MSIR] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULF 20 MG/5 ML Solution [MSIR] |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF ER 100 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF ER 15 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF ER 200 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF ER 30 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULF ER 60 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULFATE 100 mg/5 ml soln |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULFATE 15MG TABLETS |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MORPHINE SULFATE 30MG TABLETS |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MOXIFLOXACIN 0.5% EYE DROPS |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MUPIROCIN 2% CREAM |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MUPIROCIN 2% OINTMENT |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MYCAMINE 100MG/VIAL FOR INJECTION SOLUTION |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MYCAMINE 50MG VIAL |
1 |
All Formulary Drugs |
$0.00 | N/A | None |
MYCOPHENOLATE 200 MG/ML SUSP |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MYCOPHENOLATE 250 MG CAPSULE |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MYCOPHENOLATE 500 MG TABLET [CellCept] |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MYCOPHENOLIC ACID DR 180 MG TB |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MYCOPHENOLIC ACID DR 360 MG TB |
1 |
All Formulary Drugs |
$0.00 | N/A | P |
MYRBETRIQ ER 25 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | S |
MYRBETRIQ ER 50 MG TABLET |
1 |
All Formulary Drugs |
$0.00 | N/A | S |